Rankandfile.ca co-editor, Andrew Stevens, interviewed Baijayanta Mukhopadhyay, author of A Labour of Liberation. The book is published by a new, radical publisher, Changing Suns Press.
Providing care to the sick is one of the most universal labours that exists across human societies. How do we understand the work that goes into this vital collective task? How do we arrange different forms of caregiving labour? How do we decide what forms of labour remain informal and unregulated, while others remains more controlled and institutionalised? What has led to the way we prioritise and the way we value caregiving labour types? 
Baijayanta Mukhopadhyay’s Labour of Liberation explores the forms of labour – from the cognitive to the emotional, from the physical to the administrative – that go into contemporary healthcare, tracing the lineage of the hierarchies that have developed in alliance or complicity with state and capital. Through analysing the repercussions of these relationships on the care of the sick, the book questions the role of coercion and extraction in health work, and poses an argument for a more liberatory future for caregiving labour.
Tell me about the title, “A Labour of Liberation”. How does it reflect your experiences as a physician?
It doesn’t! One challenge in my medical work is to transform the clinical encounter into a political encounter. In the thousands of interactions I have now had with patients, I can count maybe four instances where I felt that we were engaged in transformational, freeing work together. Even then, I suspect much of my understanding of what happened glows in the romantic backlight of my own saviour complex. How transformational could it be if I walk away unchallenged, with my power and my privilege relatively intact, where I pat myself on the back in self-congratulation? Surely the work of caring for others should challenge and liberate me too?
The structural inadequacies of the medical system limit its potential as a liberating space, but that reality is not necessarily unique to medicine. You really have to step out of the mundane for liberation, whilst the practice of a physician is the epitome of the relentless grind of everyday life. It does give you access to a person’s deepest, most intimate stories, which when channelled appropriately, can ignite transformative experiences. But to get that wave within an individual to ripple out across a community outside the clinic? One-on-one care – which drew me to medicine for its ability to address tangible, immediate problems, which protects the vulnerable through confidentiality – nonetheless stymies people’s capacity to see patterns across illnesses.
Contemporary medicine could be seen to be inherently about control, co-opted by state and corporation as a tool for coercive conformity, so perhaps it is impossible to work for liberation within its structures. An uncomfortable perspective for one so entangled and complicit in those structures – but it’d be hard for me to get up in the morning (or at midnight) to go to work if there were absolutely no hope! That’s why I think returning medicine to its fundamental act, paring the enterprise down to the actual labour of care, the work of ensuring people are nurtured through suffering, can help us reorient healthcare to a more liberationist project.
Your book commences by talking about racism and the U.S. civil rights movement and the struggle of African American nurses. Tell me about the connection here between labour struggles, anti-racism, the development of professional hierarchies, and the structure of modern health care.
I recently came across a prose poem entitled “The Cadaver” in an anthology where a cleaner named Santiago Perez continues cleaning despite being dead. The author, Josh Bartolome, is a hospital clerk in Los Angeles. It made sense to me that it would be someone who was an observer of caring institutions who could write this searing piece on the racialised worker, who toils to make life better for others despite the impossibility of their own conditions, who only scares us when he starts to rot.
The first stirrings of A Labour of Liberation came to me when a mentor in my training noted how the most basic acts of health work is cleaning. I reflect now on how people who do this work are critical to the functioning of contemporary health institutions and are often at the frontline of risk themselves: think, most dramatically, of the people tasked with cleaning after someone dies of Ebola. Yet maintenance staff are not generally considered an integral part of the healthcare team, though their work is no less noble. I can assure you that people spurt body fluids onto hospital floors with tedious regularity, but you’ll rarely notice, because someone has quietly, efficiently cleaned up those messy, malodorous reminders of human frailty. Safe, hygienic, functional, and pleasing environments clearly facilitate healing. But they are not magical: they are made, and it is people who make them.
I’m sure that those who think about labour with more intelligence than I do have named the accelerating abstraction of what is considered work in our society: the more ethereal and conceptual it is, the less physical and tangible, the more our economy seems to value it. Actual work as defined by physics involves applying force to move something a certain distance. Our economy values a conceptual variation on work, where we reward the application of force to move people a certain way. Contemporary medicine too, as payscales would suggest, values the work of those who plan and distribute resources, more than those actually involved in moving patients from their bed to the commode, or from the emergency room stretcher to the CT-scanner. And who has access to this work that is rendered marginal? People clinging precariously to the job market, who have to fight their way in – people excluded because of their genders or their race or their migration status.
I’m certainly not the first to say that if we started to analyse work through a lens of care, if we were to value how what we do nurtures and comforts others, especially those sick or in distress, those who are young and developing, or those who are old and frail, then I suspect our understanding of a hierarchy of valuable work in healthcare – or indeed in our economy – might look very, very different.
In your book you talk about tensions between Western science and medicine and Indigenous forms of healing and understandings of health. How do you deal with these tensions in your daily practice as a physician?
As a settler, I’m not sure I have a complete grasp of what these tensions might be, as profoundly ignorant as I still am to the ways Indigenous people I work with understand health. I only have the vaguest notion of them through extrapolation of my own people’s anticolonial struggles a century ago. I am still learning, and I don’t think I’ll have an intelligent answer to this question until I do a lot more self-education.
But I am already aware of the failings of the settler system. Workers within it need to be reflective of the role healthcare actively plays in the colonial project that continues to this day in Canada. We represent institutions that perpetuated racial segregation in the name of care: it is still not clear to me that the fear of tuberculosis spreading to the white population was not really just a convenient excuse to remove Indigenous people from their lands. We also represent institutions that, in the spirit of the treaties, can still be considered to come under the authority of the coercive Indian agent, the medicine chest under his control; many healthcare stations in remote communities are still managed by the federal government, subject to administrative whims that do not respond to local realities. And we still take people away from their home, send them to Winnipeg or Montreal for care – allegedly for their own good, a reality people may accept, but one that cannot seem far from the history of removing people from their land “for their own good” over and over again.
Indigenous healing traditions survive to this day, but what I find most tragic is the destruction colonialism has wrought on the bodies of knowledge on healing that were evolving on this continent. Colonialism destroys a people’s intimacy with their land in order to enforce dependence on systems and knowledges that are imposed by empire. If people are disconnected from their local environment, then it remains unprotected and open to exploitation. I think that dynamic has extended to healing knowledge as well.
Indigenous healers I have spoken with have dismissed externally imposed standards, challenging me to question what I consider valid knowledge. And from my own colonial heritage, I wonder whether we must not recognise the weight of empirical knowledge, the applied science of trial-and-error, as the basis of so much of what people have done in order to survive, as the source of so much rich wisdom that has been accumulated and passed on across generations? We can sneer about the paucity of evidence in Indigenous medical traditions now – but that alleged lack is our own creation. We destroyed languages in which this science was communicated, expropriated ecosystems in which it was applied, and disrupted social structures within which it was practiced. Isn’t it as if we were to ban the use of English (the language of contemporary science), board up all the pharmaceutical factories, and tear down all the hospitals – and then mocked modern medicine for not working?
There’s a point in your book when you reflect on a patient’s embarrassment when they used traditional medicine – goose fat – and lessons from a grandmother to deal with a breastfeeding problem. Have these moments transformed how you practice medicine?
I wish I could say that I have become a transformed, enlightened practitioner. But I haven’t. I still know the medicine I know – and despite its limitations, with all its faults and foibles, I think it can bring valuable good to a community if appropriately channelled and controlled. But I also think it is one practice amongst many of engaging in healing work. Learning how to collaborate across these diverse traditions seems crucial to me as we always work with imperfect information. If we had unlimited time and resources, and also suitable tools to gather all the data from the most minute shifts at the level of intracellular function to the implications of historical trauma generations ago on a person’s response to stress, then I think we would do medicine flawlessly.
But we don’t. That’s why I think it’s ill-advised to dismiss information when it is provided from different contexts. I’ve certainly learned my lesson in that sense, reeling as I am from a recent diagnosis that I wonder we would not have missed if we stopped focusing on our tests, and listened to an Indigenous elder’s perspective instead. It is of course essential to know good information from misinformation, to be able to evaluate what is relevant in a narrative from what is superfluous. That’s part of the cognitive labour of engaging in healing work: processing information to elucidate the underlying form. It’s finding the balance between a person’s inner expertise of their experience, and placing that in the context of the healer’s knowledge of having seen countless patterns repeat across a broad range of people.
I was lucky enough to train in a multidisciplinary setting where I often would not make clinical decisions without first consulting the dietitian, the respiratory therapist, the physiotherapist, the occupational therapist, the nurse, the pharmacist, the social worker, the speech and language pathologist. All of those perspectives enriched my understanding of a person’s capacity to function in a world, a person’s pathway on the road to healing. Just imagine including more sources of information, more ways of understanding of how a person’s journey through illness and health fit into the complexities of our worlds.
Check out the second part of Rankandfile.ca’s interview with Baijayanta Mukhopadhyay here.